Journal of the American College of Surgeons
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The mechanism by which pancreatic ductal adenocarcinoma (PDA) cells escape immune detection and survive in lymph nodes is poorly understood. One possible mechanism by which PDA cells can escape immune detection is through upregulation of indoleamine 2,3-dioxygenase (IDO), an enzyme that can starve T lymphocytes of tryptophan. ⋯ These data support the notion that metastatic PDA cells select for overexpression of IDO to evade immunologic detection. Future studies will define whether IDO expression in PDA patients with lymph node-positive metastases correlates with decreased survival. In addition, inhibition of IDO in PDA patients can be useful to enhance immunotherapeutic strategies.
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The concept that premenopausal female patients are more resistant to shock than male patients has been shown in numerous preclinical models. The more relevant effect of gender on clinically important outcomes after trauma is less clear. Clinical studies have been conflicting, both supporting and refuting the protective effects of gender on outcomes, primarily because of limitations in sample size and patient stratification. In an attempt to resolve this ongoing dispute, we evaluated the effect of gender on various outcomes in the largest single institutional series of trauma patients reported in the literature after blunt injury. ⋯ Multivariable logistic regression analysis of a large trauma cohort definitively establishes that gender is not independently associated with mortality after blunt trauma in humans. In contrast, male gender was shown to be associated with increased morbidity. Unlike rodent studies, gender alone offers no survival advantage in humans after blunt trauma.
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We reviewed our obesity surgery database for 2 experienced bariatric surgeons since their last patient death in October 2003 through July 2007. ⋯ Results for laparoscopic Roux-en-Y gastric bypass improve with experience and can be taught in an academic training program, with low morbidity and mortality. Routine postoperative upper gastrointestinal contrast studies are unnecessary and may lengthen hospital stay.
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Comparative Study
Does race influence outcomes after primary liver transplantation? A 23-year experience with 2,700 patients.
Data about the influence of race on survival after liver transplantation (LT) are limited and conflicting. This study was undertaken to evaluate longterm outcomes for LT in African-American (AA) recipients compared with recipients of other races and to determine factors responsible for any observed differences. ⋯ This is the first study to demonstrate equivalent longterm results after LT for AA and other races. Modern immunosuppression with tacrolimus substantially lowered rejection rates and improved graft and patient survival after LT.
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Reoperation for hyperparathyroidism (HPT) carries an increased risk for morbidity and failure to cure. Accurate preoperative localization minimizes operative risk but is often difficult to achieve in the reoperative setting. Four-dimensional computed tomography (4D-CT) is an emerging technique that uses functional parathyroid anatomy for precise preoperative localization. We evaluated 4D-CT as a tool for localization of hyperfunctioning parathyroid tissue in the reoperative setting. ⋯ Four-dimensional-CT is an ideal tool for preoperative localization of hyperfunctioning parathyroid tissue in the reoperative setting. Localization and successful reoperation are most difficult in patients who have undergone an earlier operation that included resection of at least one hypercellular parathyroid suggesting multigland disease.